Is Sex Therapy the Same for Same-Sex Relationships?

February 7, 2019

Couples in love share many things in common. They like to spend time together. They have things they enjoy, like scuba diving or cooking. They are often affectionate and get their physical needs met from one another. And, for better or worse, even the most loving couples experience conflict. These commonalities hold true for couples whatever the sexual orientation of the partners. For that reason, much of what couples therapists learn can be applied across the board.

But there are also significant differences for same-sex partnerships that sex therapists need to know. Sex therapists deal with the whole of human sexuality—not just problems related to the act of “sex” or intercourse, but to how people feel about their orientation, gender, and expression of their sexuality. That is why same-sex partners often turn to sex therapists, who generally know more than other couples therapists about these differences.

What are these differences? One is that people who belong to sexual minorities often experience minority stress. Minority stress comes just from the fact of being different from the mainstream and as such having to experience with stigmatization, discrimination, and even aggression. Being in an intimate relationship is stressful for most people because it requires psychological work. Add in minority stress and maintaining a relationship may be more difficult for same-sex partners. This needs to be normalized and understood so that same-sex couples can recognize when it is affecting one or both of them. Doing so may decrease tension and make it easier to manage conflict.

While heterosexual couples never have a concern about being open regarding their opposite-sex orientation, same-sex partners may not be out publicly to others at the same level. One partner may be completely out to family, friends, and colleagues, while the other may keep their orientation private from one, two, or all three of these groups. For some same-sex couples, this doesn’t seem to be an issue. For others, being out in different ways can create miscommunication and hurt feelings. I think about a couple I worked with wherein one couldn’t wait to visit a gay-friendly city and hold hands on the street, while the other was still guarded about being seen by someone and reporting their gay status to family members.

Another difference has to does have to do with sex. Interestingly, while lesbian couples have the least amount of sex, they seem to be the most satisfied group. Lesbian couples report that they spend more time in foreplay and engage in clitoral stimulation which works well for women in general. Gay men, however, appear prone to sexual problems, including erectile dysfunction and delayed ejaculation. They may need to overcome sexual shame in order to be fully sexual with another man, a type of shame with which sex therapists are all too familiar.

Same-sex couples, especially gay males, are also more likely than are straight couples to have open relationships or marriages. Gay male partners, for example, may readily agree that they may have other partners, though they may disagree as to how frequently they may seek an outside partner, whether or not it is okay to develop an emotional connection, and so on. These are parameters that may need to be negotiated in the sex therapist’s office. Sometimes lesbian partners also allow for open relationships, but one example of a problem that may ensue is if one partner’s sexuality becomes more fluid and wishes to have sexual activity with a male partner. The sex therapist may need to explore the concept of fluidity and create an understanding, though partners still may need to decide if an open relationship fits both of their needs.

Just as with heterosexual couples, there are no real stereotypes for same-sex couples. Each couple is different, and each partner brings their individual psyche and experiences to the relationship. The sex therapist needs to avoid making assumptions about same-sex couples, even those that are presented in this post. Questions may be asked, but it is best to listen carefully first and hear how the same-sex couple navigates their relationship. The beauty, if you will, of same-sex couples is that in their own community, they generally are not held to strict rules or traditional stereotypes. They can make their own way, which can be challenging but also presents an opportunity to create a relationship that is unique. When needed, the details of the relationship contract can be worked out in the non-judgmental environment of the sex therapist’s office.